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Michael Petruzzelli

, National Council for Behavioral Health

Without “Doc Fix” Bill, Important CMS Provisions Expired on April 1

April 2, 2015 | Medicare | Comments
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In addition to the expiration of the temporary fix preventing a scheduled 21% cut to Medicare physician pay, a number of provisions affecting providers expired at the end of March (also called “extenders”). The Centers for Medicare and Medicaid Services (CMS) updated providers on these expired provisions as it begins taking necessary steps to implement these changes. CMS said in a statement, that it “is working to limit any impact to Medicare providers and beneficiaries as much as possible.”

These expiring provisions include:

  • Exceptions process for Medicare Part B outpatient therapy caps—Provisions for an exceptions process for annual per beneficiary cap amounts for occupational or physical therapy. Such treatment is provided to those with serious physical, mental, or cognitive disorders that require intensive therapy. Under current law, exceptions to these caps were allowed for reasonable and necessary services. This exception process expired March 31, 2015.
  • Payments for Low-Volume Hospitals and Medicare Dependent Hospitals —Provisions for additional payments for low-volume hospitals that meet certain discharge and mileage criteria and for small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges.  These additional payments expired April 1, 2015.
  • Add-on Payments for Ambulance Services— Provisions for additional payments for an increase in the ambulance fee schedule amounts for covered ground ambulance transports from rural and urban areas by three and two percent, respectively.  In addition, provisions for a 22.6 percent increase in the base rate of the ambulance fee schedule amount for covered ground ambulance transports from designated “super rural” areas. These additional payments expired April 1, 2015.
  • Recovery Auditor Inpatient Hospital Status Reviews—Provisions to prohibit Recovery Auditor inpatient hospital patient status reviews for dates of admission occurring between October 1, 2013 and April 30, 2015. In addition, CMS will continue the Inpatient Probe and Educate process through April 30, 2015.